Arthroscopic Hip Labral Reconstruction and Augmentation Using Knotless Anchors  Mark O. McConkey, M.D., Brett Moreira, M.B.B.S., Omer Mei-Dan, M.D.  Arthroscopy Techniques  Volume 4, Issue 6, Pages e701-e705 (December 2015) DOI: 10.1016/j.eats.2015.07.016 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 A labral “augmentation” allograft is shown in a left hip from the mid-trochanteric portal. The tensor fascia lata (white asterisk) graft has been augmented to the remnant, deficient labrum seen inferior to the graft (black asterisk) with 2 anchors and ultrahigh-strength sutures (yellow dashed lines). This preserves the longitudinal circumferential fibers of the native labrum to obtain better contact with the femoral head and improve the suction-seal effect, while generating a more robust labral construct. This technique is very useful in patients with borderline dysplasia when reinforcing the labrum and improving the femoral head coverage, which improves joint stability. This technique is also useful in native labral tissue that rests away (with a visible gap) from the femoral head when traction is off, lacking a suction-seal effect. The graft in these cases would push the labrum downward to restore contact between the femoral head and labrum. (C, capsule; FH, femoral head.) Arthroscopy Techniques 2015 4, e701-e705DOI: (10.1016/j.eats.2015.07.016) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 Graft preparation is performed on the back table. (A) The graft is prepared to a length of 110% of the required length. The graft is whipstitched with No. 2 Vicryl suture (purple stitch) to reduce its tendency to absorb fluids and prevent excess swelling once in the joint. The Vicryl is stitched through 1 side of the graft only (the capsular side), leaving 1 side free of suture material (joint side). (B) The graft has been trimmed to the appropriate length, and ultrahigh-strength sutures have been placed on each end in 2 separate colors. This enables easier suture management once inside the joint. The Vicryl-free side of the graft is seen (asterisk). Arthroscopy Techniques 2015 4, e701-e705DOI: (10.1016/j.eats.2015.07.016) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 (A) With the camera in the mid-trochanteric portal in a left hip, a SpeedLock Hip anchor (SHL) is being placed after sutures have been passed through the labral graft (asterisk) in a “labral base” stitch fashion in its mid portion. Before this, the labrum has been secured at both ends, turning it into a bucket handle–type construct. (B) A graft that has been fully secured, before releasing traction applied on the femur. The Vicryl-free side of the labrum is seen facing the joint/femoral head (black asterisk), whereas the Vicryl-stitched side is facing the capsule (white asterisk). (C, capsule; FH, femoral head.) Arthroscopy Techniques 2015 4, e701-e705DOI: (10.1016/j.eats.2015.07.016) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions